title: Fresh frozen plasma as a successful antidotal supplement in acute organophosphate poisoning.
abstract: Despite improvements to intensive care management and specific pharmacological treatments (atropine, oxime, diazepam), the mortality associated with organophosphate (OP) poisoning has not substantially decreased. The objective of this examination was to describe the role of fresh frozen plasma (FFP) in acute OP poisoning. After a deliberate ingestion of malathion, a 55-year-old male suffering from miosis, somnolence, bradycardia, muscular fasciculations, rales on auscultation, respiratory insufficiency, as well as from an inhibition of red blood cell acetylcholinesterase (AChE) and plasma butyrylcholinesterase (BuChE), was admitted to hospital. Malathion was confirmed in a concentration of 18.01 mg L(-1). Apart from supportive measures (including mechanical ventilation for four days), antidotal treatment with atropine, oxime-pralidoxime methylsulphate (Contrathion(R)), and diazepam was administered, along with FFP. The potentially beneficial effects of FFP therapy included a prompt increase of BuChE activity (from 926 IU L(-1) to 3277 IU L(-1); reference range from 7000 IU L(-1) to 19000 IU L(-1)) and a reduction in the malathion concentration, followed by clinical recovery. Due to BuChE replacement, albumin content, and volume restitution, FFP treatment may be used as an alternative approach in patients with acute OP poisoning, especially when oximes are not available.
authors.affiliation: National Poison Control Centre, Medical Faculty, Military Medical Academy, University of Defence, Belgrade, Serbia.
authors.forename: Slavica
authors.initials: S
authors.lastname: Vučinić
authors.forename: Milica
authors.initials: M
authors.lastname: Zlatković
authors.forename: Biljana
authors.initials: B
authors.lastname: Antonijević
authors.forename: Marijana
authors.initials: M
authors.lastname: Ćurčić
authors.forename: Bogdan
authors.initials: B
authors.lastname: Bošković
mesh_terms: D000110:Acetylcholinesterase / Q000378:metabolism; D000931:Antidotes / Q000627:therapeutic use*; D001285:Atropine / Q000008:administration & dosage; D001803:Blood Transfusion; D002091:Butyrylcholinesterase / Q000378:metabolism; D004912:Erythrocytes / Q000201:enzymology; D005751:Gastric Lavage; D006801:Humans; D007306:Insecticides / Q000506:poisoning*; D008294:Malathion / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D062025:Organophosphate Poisoning / Q000201:enzymology / Q000628:therapy*; D010949:Plasma; D011220:Pralidoxime Compounds / Q000008:administration & dosage; D012709:Serum Albumin / Q000378:metabolism; D000075462:Serum Albumin, Human
chemical_list: D000931:Antidotes; D007306:Insecticides; D011220:Pralidoxime Compounds; D012709:Serum Albumin; C402606:albumin Amsterdam; D001285:Atropine; D000110:Acetylcholinesterase; D002091:Butyrylcholinesterase; C028797:pralidoxime; D008294:Malathion; D000075462:Serum Albumin, Human